Long-term Follow-up after in situ Graft Replacement in Patients with Aortofemoral Graft Infections

Aortic graft infection is among the most dreaded complications in vascular surgery. Regardless of management, it leads to high morbidity and mortality. Successful treatment traditionally involves removal of the infected prosthesis and revascularisation of the lower extremities by an extra-anatomic bypass. >3 Initial reviews of institutional series of patients with aortic graft infection emphasised the immediate postoperative mortality and morbidity. The long-term success of conventional treatment is measured in terms of patient survival, limb salvage and the abscence of complications related to graft excision, for example aortic stump blow-out. 4-1° As a treatment option for selected patients no clinical evidence of septicaemia or retroperitoneal purulent collections and no bacteriological evidence of pseudomonas infectionmany vascular surgeons now prefer in situ graft replacement of an infected aortic graft. ~>~9 Its long-term success should be measured in terms of persistent retroperitoneal infections that can develop even years after graft replacement. Late infectious complications most commonly arise in patients with primary graft infections caused by the less virulent micro-organism, for example coagulasenegative Staphylococcus epidermidis. 19 Hence the need for clinical and diagnostic imaging follow-up for reliable retroperitoneal surveillance. Newly introduced functional diagnostic techniques capable of detecting graft infections in their early stages, notably leukocytelabelled 99m HMPAO Technetium Scintigraphy (99mTc), seem to meet this requirement. 2°-22 We report a long-term follow-up (mean 37 months) of 18 patients, nine with an aortoenteric erosion (AEE)